What size am I? I thought I was a 32DDD or 34DD. But my surgeon thinks I’m a D cup? (Photo)

Hello, thank you for your photos and question. The only thing that is important to the insurance is the grams that can be removed. This number is already figured out by your insurance co and you have to meet those goals or that number based off your height, weight and BMI. These numbers will give a BSA score and your insurance will decide if its covered off that. The surgeon can give his recommendations on what he or she can safely remove, but remember you want them to only remove what they feel is safe at the time as you don't want lose of blood supply to the nipple with removing to much just to reach an insurance goal.

Hello. I agree with colleagues above. You would most benefit from lifting and mild reduction which suits your silhouette. Happy to answer any questions. Thanks

From the sides of your breasts, it is unlikely that you will qualify for a breast reduction by insurance. The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

Your doctor is correct. You really need a lift and maybe a little bit of breast tissue removed. Insurance very unlikely to cover it

Cup sizes are not exact and can vary by bra manufacturer. From the submitted photos and your stated goals you appear to be a better candidate for a small reduction with a lift. You can consider auto augmentation as well which uses your own tissue to give more upper pole fullness. This is different than fat grafting. I've included a video that I hope you find helpful.

Your surgeon is correct. Insurance does usually require about 500 grams to be removed from each breast. If you pay out of pocket, you can have a small reduction.

Bra size can vary significantly from brand to brand so it is usually not reliable. I agree with the other surgeons who have responded saying that you would benefit mostly from a small reduction and a lift to get you to your desired size. Insurance will not cover the procedure unless you surgeon agrees to remove the amount they dictate. It is up to your surgeon to determine whether or not this can be done safely. If he/she is concerned about blood flow then your surgeon will suggest a cosmetic reduction/lift

This is not an issue for the surgeon. It is an issue about insurance. You may well have significant symptoms related to lifting your breasts because of their ptotic nature.

You do not look to be a triple D. Let’s say, for most patients 200 g is needed per bra cup size sometimes a bit more sometimes a bit less depending on stature.

Look at a 1 L soda bottle. Most insurance companies require that amount to be removed split between both breasts. I know this is not “fair” but it is the reality of the insurance world.

At this juncture, your best option is to just pay for the surgery yourself to get what you really want.

Generally speaking, I recommend all patients have multiple in person, consultations before considering selecting a provider for any plastic surgery operation.
When breast reduction is done through medical insurance, the surgeons reimbursement is going to be a tiny fraction of what the cash typical fee is.
If the surgeon accepts insurance payment, then they cannot co-bill the patient for the difference.
I’m going to guess that typical insurance reimbursement for breast reduction surgery is probably around $1100.
Were you given a price quote for the procedure if insurance doesn’t pay for it? If so, you probably realize that the typical fee for the surgeon is probably many times more than what insurance reimbursement is going to pay.
Some plastic surgeons are happy to accept and work with medical insurance while others do it occasionally and some don’t work with medical insurance reimbursement at all.
Look for plastic surgeons in your community who do a lot of breast cancer reconstruction.
These surgeons typically have the best and the most breast surgery experience Including a lot of reduction surgery.
If you go to the plastic surgeons who mostly do cosmetic surgery, they’re going to want to get paid as a cosmetic procedure.
Breast reduction is a covered benefit under almost all medical insurance policies in the United States.
If you’re having neck and back pain or skin irritation, then breast reduction, surgery is typically a covered benefit.
Most insurance companies have a certain amount of tissue that needs to be removed in order for the procedure to be authorized. If less is removed, it is possibly and potentially considered a cosmetic procedure.
The total amount of tissue that removed is always going to be an estimate when the doctor requests insurance authorization.
There is a potential issue if the surgeon Tells the insurance company that 700 g of tissue will most likely need to be removed, the procedure is authorized and then only 200 g of tissue was removed during the operation.
While I’ve never heard of an insurance company, reversing previously authorized surgery. It is possible this could happen in the patient would now be stuck with an astronomically high bill.
When medical procedures are done, using medical insurance billing is usually done at many times higher rates than the actual compensation or reimbursement.
This will be true from the anesthesiologist and the operating room as well.
It’s not unusual for an operating room to bill $40,000 even though they may only collect $2000 from insurance because of pre-negotiated rates.
When an individual gets stuck with hospital bills without having pre-negotiated payment amounts the dollar amounts can become astronomical.
This is unlikely to happen after a breast reduction procedure, but there is always some uncertainty depending on the estimated volume of breast tissue removed compared to what is required from the insurance companies policy.
Hopefully my description isn’t confusing you too much.
In a nutshell, I recommend you have a few more consultations looking exclusively for plastic surgeons who do a lot of reconstructive type surgery.
Most communities will have a breast center where breast cancer patients and breast reconstruction is done.
Look for plastic surgeons involved with this type of care.
In my opinion, you are a very straightforward breast reduction candidate, and should have the procedure covered by insurance and end up with a nice full C cup breast. That should look great and give you some symptomatic relief.
Look for providers, willing to work with you and your insurance and not those trying to get you to pay for the entire procedure which will be expensive even if done as a cosmetic procedure based on cosmetic facility and anesthesia rates(these rates are different for insurance based work)
This should be an insurance covered operation in my opinion.
There is some subjectivity to this topic, and it is reasonable for different plastic surgeons to have different opinions. it’s also completely reasonable for plastic surgeons to not want to accept insurance reimbursement.
While $1100 may seem like a lot of money it’s not enough to pay for a plastic surgeons overhead and still be profitable for most providers.Actual insurance reimbursement may be substantially different as well. it could be more, and it could be less.
I’m only giving estimates based on my experience in the past.
When, in doubt, slow down and schedule a few more consultations.
Best,
Mats Hagstrom, MD